1. Demographic Information

Thank you for your willingness to participate in this important survey.

The survey requires 15 to 20 minutes of your time. If you complete the survey, you will be offered two thank you gifts. You can choose either or both of them. They are: A summary of the survey results and/or a copy of our e-book, "102 Tips for a Balance Life." Both will be available Fall 2008.

Please answer the following questions. They provide valuable classification and sorting data so that we can generate the most accurate representation of current work-life issues. Your responses are encrypted for your security. Your information will not be sold or shared.

Note: You may remain anonymous by using the "dummy" email address in the first question. For your answers to count and to receive the thank-you gifts, you must complete the survey.

* 1. Only your City, State, Zip Code and Email address are required. If you choose to remain completely anonymous, and no not wish to receive the survey results, simply enter the following "dummy" email address. Remember that if you do so, we will not be able to contact you or send you the results of this survey.

To remain anonymous: responder@integrityhpi.com

* 4. Ethnic Identity: Please choose all that apply.

* 5. Your Date of Birth:

Your Date of Birth

* 7. How many people in your household require supervision or special care? Please enter whole numbers. If no-one requires special care, please answer "0".